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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005678
Report Date: 12/08/2022
Date Signed: 12/08/2022 04:51:01 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2020 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200805131135
FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
306005678
ADMINISTRATOR:AHAOMA S. ONYEBUCHIFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 860-4016
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 118DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Christine ChonTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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9
Staff preventing resident from getting their medication.
Resident bathroom is not wheelchair accessible.
Resident's bathing needs are not being met.
Resident does not have a working wheelchair.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation. LPA met with Executive Director Christine Chon and explained the reason for the visit. In regard to the allegation, staff preventing resident from getting their medication the investigation revealed the following, Resident 1’s (R1) medications are handled by the facility. R1 has both routine medications and PRN medications prescribed by his doctor. It was reported that R1 was not provided Temazepam or Dulcolax. A review of records revealed that R1 was not prescribed Dulcolax, R1 was prescribed Docusate Sodium once per day in soft gel beginning 11/12/2019. R1 acknowledges they were prescribed Docusate Sodium but thought that it was called Dulcolax which they have used in the past. R1 stated it was possible they got the name wrong. R1 acknowledged that both medications (Dulcolax and Docusate Sodium) are for the same issue and would most likely not be prescribed at the same time. It was reported that R1 was prescribed Temazepam for August and September 2020. Records Reviewed showed R1 was not prescribed Temazepam until 9/24/2020.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 22-AS-20200805131135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE
FACILITY NUMBER: 306005678
VISIT DATE: 12/08/2022
NARRATIVE
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Facility staff informed R1 he would have to contact the doctor to arrange for services or pay extra to receive additional services. R1 declined to pay for additional services. R1 verified that his doctor informed him it was no longer necessary because he had recovered from his hospital visit. Therefore, the allegation is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis. In regard to the allegation, resident does not have a working wheelchair, the investigation revealed the following, R1 had a wheelchair that broke and was no longer functional. The facility provided R1 with a wheelchair free of charge. The wheelchair was not electric like R1’s previous wheelchair. R1 reported he could get around in the new wheelchair, but it took more time to get everywhere. R1 stated the facility should provide them with a wheelchair like the old one. R1 provided the facility with a prescription for a wheelchair and the facility contacted Cal-Optima with the prescription and Cal-Optima informed the facility the prescription would not be honored but did not provide details. The facility contacted R1’s doctor and the doctor’s office would only re-fax the prescription and would not contact the medical equipment provider or Cal-Optima. R1 contacted the doctor and the doctor only provided a copy of the prescription for the wheelchair. The facility contacted a non-profit organization and the third-party provider, provided R1 with a wheelchair. R1 verified that he received a wheelchair and it works fine. R1 stated that they thought the facility should provide him with a wheelchair. The facility is not required to provide or pay for R1’s wheelchair but the facility assisted R1 and found a third-party provider that gave R1 a wheelchair free of charge. R1 currently has a working wheelchair and was never without a working wheelchair. Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 22-AS-20200805131135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HARBOR HEIGHTS ASSISTED LIVING & MEMORY CARE
FACILITY NUMBER: 306005678
VISIT DATE: 12/08/2022
NARRATIVE
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The records review showed R1 was not prescribed Temazepam in August 2020 or for the first 3 weeks of September 2020. Facility staff reported that R1 has received all their prescribed medication. R1 reported that they have received all their medication except Dulcolax and Temazepam. Facility staff reported they contacted R1’s doctor informing the doctor R1 requested Temazepam. R1 reported they contacted their doctor to request Temazepam. None of the evidence gathered supports the allegation. Based on the evidence gathered through record review and interviews the allegation is deemed to be, Unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis.

In regard to the allegation, resident bathroom is not wheelchair accessible, the investigation revealed the following, R1 uses a wheelchair and reported the bathroom doorway is not wide enough for the wheelchair to pass through. When this information was made known to the facility the Administrator offered R1 a new room with a wider bathroom doorway for the same monthly rent as R1’s current room. R1 refused and insisted that the doorway be widened because R1 did not wish to change rooms. The Administrator explained to R1 that widening the doorway would not be possible and would change the walls of the room and require extensive work for many days. The Administrator informed R1 that moving to a new room which has more space and a larger bathroom would be beneficial, but R1 refused to move. R1 reported that they would make do and get into and out of the bathroom even though the wheelchair rubs the doorway. The facility was willing to accommodate R1 by providing him a larger room with a larger bathroom without an increase in rent when R1 reported the bathroom doorway would not accommodate the wheelchair but R1 refused to move and insisted on staying in their current room. Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false could not have happened and/or is without a reasonable basis.

In regard to the allegation, resident’s bathing needs are not being met, the investigation revealed the following, R1’s admission agreement specifies R1 agreed to receive bathing twice a week. R1 verified the admission agreement is correct. R1 reported they were receiving bathing 3 times a week. Administrator and R1 verified that for around two weeks R1 was receiving home health services from a third party after he discharged from the hospital. Part of the home health service was to provide bathing assistance once a week. This was temporary to assist R1 after they came home from the hospital. R1 reported they should continue to receive bathing 3 times a week. Staff reported they informed R1 the third bath a week was provided from a third party and not part of his regular services he receives from the facility.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2020 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200805131135

FACILITY NAME:HARBOR HEIGHTS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
306005678
ADMINISTRATOR:AHAOMA S. ONYEBUCHIFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 860-4016
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 118DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Christine ChonTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not keeping the facility free of pests.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre met with Administrator Christine Chon to deliver the findings of the investigation into the allegation listed above. In regard to the allegation, staff are not keeping the facility free of pests, the investigation revealed the following, R1 reported that mice are present in their room. R1 reported that the facility has not done anything to prevent mice from being in his room. 5 out of 5 residents interviewed reported they have never seen mice anywhere in the facility. None of the staff interviewed reported ever seeing any mice. Staff reported there are traps outside of the facility, but they have never seen a mouse in one. An inspection of the facility and R1’s room showed no evidence of rodents or insects. There was no clear entry point for any vermin into R1’s room other than the entrance door. There was a mouse trap in R1’s room but it was empty. R1 verified no mice have been caught in the room. R1 and staff verified that the mouse trap was put in R1’s room at his request. Based on the evidence gathered the allegation, staff are not keeping the facility free of pests, is deemed Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4